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HEPATIC

ABCESSES

Oleh
DIAN ISTIQAMAH
MARDHATILLAH
Abstrak
 Hepatic abscesses are potentially lethal
diseases if early diagnosis and treatment are
not instituted.
 Imaging modalities like ultrasonography and
CT scan have become the cornerstone of
diagnosis.
 Though antibiotics have remained the
principal modality of management,
percutaneous drainage of abscesses have
vastly improved the chances of cure and
bring down the morbidity drastically in
pyogenic abscesses.
Introduction
 Liver abscesses are relatively uncommon in the
Western countries, but in India and the Asian
countries. Though the mortality has
considerably decreased, the morbidity and
associated loss of man hours are a concern.
 With increase in incidence of
immunosuppression following organ
transplantation, AIDS, diabetes and cirrhosis
there is a progressive rise in fungal and
mycobacterial abscesses adding a new
dimension to the problem.
Tipes
 Pyogenic: nonspecific bacterial,
mycobacterial, fungal
 Amoebic
Pyogenic abscess

Aetiopathogenesis
Rute
Most common route of infection is the biliary
tract. Malignancy in the biliary tree causing
obstruction, cholangitis and abscess, it is due
to choledocholithiasis. Systemic
bacteraemic infections has the potential to
seed the liver through the hepatic artery
from infected cardiac valves, endocarditis,
IV drug users, pneumonitis, osteomyelitis
apart from transarterial procedures like
chemoembolization and radiofrequency
ablation of malignancies.
Pyogenic abscess

ORGANISMS
E. coli and Klebsiella are the commonest
isolated organisms followed by
staphylococcus aureus, enterococcus,
streptococcus and bacteroides.
Mycobacterium and fungal growths are
extremely rare.
Pyogenic abscess

Treatment options
 Antibiotics alone
 Antibiotics in combination with
 Closed aspiration
 Percutaneous catheter drainage
 Surgical drainage - laparoscopic
Amoebic

Aetiopathogenesis
Entamoeba histolytica, the causative
organism of amoebiasis. It exists both in
the vegetative (trophozoite) and cyst
forms in the humans. They enter the liver
via the portal circulation and cause
hepatic abscesses, spread to the systemic
circulation thereafter and cause
abscesses elsewhere or may revert back
to the cyst phase and get excreted in the
stools to reinfect fresh hosts by the faecal
- oral route.
Amoebic

Complications
 Rupture is the only complication and is often
into the peritoneal cavity, thus raising the
morbidity and mortality. Pleuropulmonary
rupture is less frequently seen, and in
abscesses close to the dome. Rare ruptures
into the pericardial cavity are reported and
need urgent aspiration.
Amoebic

Imaging
 Chest X-rays
 Ultrasonography abdomen
 CT scan
 MRI
Amoebic

Treatment options
 Anti amoebic drugs - Nitroimidazoles and
other luminal amoebicides
 Nitroimidazoles in combination with
luminal amoebicides and
 Closed aspiration
 Percutaneous catheter drainage
 Surgical drainage - open or laparoscopic
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